ENVIRONMENTAL IMPACT OF RELAPSING-REMITTING MULTIPLE SCLEROSIS TREATMENTS ACROSS EUROPE: IMPLICATIONS FOR SUSTAINABLE PRESCRIPTION
Author(s)
Maria Reyes Abad, MSc1, Camilla Ferri, MSc2, Massimo Filippi, PhD3, Josep Maria Guiu Segura, MSc4, Alicia Herrero, MSc5, SUSANA ACEITUNO, MSc6, Sandra Garde, MSc6, Miriam Prades, MSc6, Bleric Alcalá, MSc7, Isabel Klinnert, BA8, Anna Maria Provenzano, MSc9, Heidi de los Santos Real, PhD7, Lisa Schlereth, MSc10, Roshkan Srinathan, MSc11, Melinda Magyari, PhD12, Ásta Theódórsdóttir, PhD13, Enrico Tomasi, MSc2, Peter Vestergaard Rasmussen, PhD14, Chiara Zanetta, MSc15.
1Hospital Pharmacy Department. Hospital Universitario Miguel Servet, Zaragoza, Spain, 2Hospital Pharmacy Department. IRCCS San Raffaele Scientific Institute, Milan, Italy, 3Vita-Salute San Raffaele University, Neurology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy, 4Pharmacy Service. Xarxa Santa Tecla, Sanitaria Social i Docent, Tarragona, Spain, 5Hospital Pharmacy Department. Hospital Universitario La Paz, Madrid, Spain, 6Antares Evidenze Health Consulting, Barcelona, Spain, 7Merck S.L.U., Madrid, Spain, an affiliate of Merck KGaA, Darmstadt, Germany, 8Merck KGaA, Darmstadt, Germany, 9Merck S.L.U, Roma, Italy, an affiliate of Merck KGaA, Darmstadt, Germany, 10Ares Trading S.A. - An affiliate of Merck Serono S.A., Eysins, Switzerland, 11Merck Denmark A/S, Søborg, Denmark, 12Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, 13Neurology Department. Odense University Hospital (OUH), Odense, Denmark, 14Aarhus University Hospital (AUH), Aarhus, Denmark, 15Neurology Department. IRCCS San Raffaele Scientific Institute, Milan, Italy.
1Hospital Pharmacy Department. Hospital Universitario Miguel Servet, Zaragoza, Spain, 2Hospital Pharmacy Department. IRCCS San Raffaele Scientific Institute, Milan, Italy, 3Vita-Salute San Raffaele University, Neurology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy, 4Pharmacy Service. Xarxa Santa Tecla, Sanitaria Social i Docent, Tarragona, Spain, 5Hospital Pharmacy Department. Hospital Universitario La Paz, Madrid, Spain, 6Antares Evidenze Health Consulting, Barcelona, Spain, 7Merck S.L.U., Madrid, Spain, an affiliate of Merck KGaA, Darmstadt, Germany, 8Merck KGaA, Darmstadt, Germany, 9Merck S.L.U, Roma, Italy, an affiliate of Merck KGaA, Darmstadt, Germany, 10Ares Trading S.A. - An affiliate of Merck Serono S.A., Eysins, Switzerland, 11Merck Denmark A/S, Søborg, Denmark, 12Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, 13Neurology Department. Odense University Hospital (OUH), Odense, Denmark, 14Aarhus University Hospital (AUH), Aarhus, Denmark, 15Neurology Department. IRCCS San Raffaele Scientific Institute, Milan, Italy.
OBJECTIVES: Aligning treatment decisions with United Nations Sustainable Development Goals supports patient outcomes and environmental sustainability in chronic diseases such as multiple sclerosis. This study assessed CO₂e emissions associated with reimbursed relapsing-remitting multiple sclerosis (RRMS) treatments in Italy, Spain, UK, and Denmark during the patient use-phase, in accordance with the Summary of Product Characteristics (SmPC) requirements.
METHODS: An Excel-based tool was developed to estimate carbon dioxide equivalent (CO₂e) emissions linked to RRMS treatment use following SmPC guidance over a four-year time horizon. Model inputs were sourced from official databases and published literature and subsequently validated by healthcare experts from each country. Emission factors were applied to calculate CO₂e emissions across three domains: medical provider resource use (facility energy consumption and medical devices), patient transportation (distance, visit frequency, modes of transport, and fuel types), and waste generation (units and kilograms by category). Optimization of visits (combining tests or treatment administration) was restricted to reflect real-world practice in Italy, Spain, UK, and Denmark. The analysis followed the Sustainable Care Pathways framework and Publicly Available Specification 2090:2025.
RESULTS: Average annual patient use-phase emissions were 34, 41 and 16kg CO2e in Spain, Italy and Denmark, respectively. Oral treatments consistently showed the lowest mean emissions (32, 35 and 13kg CO₂e/year, respectively), particularly cladribine tablets (7, 13 and 5kg CO₂e/year, respectively), compared with subcutaneous and intravenous options (34, 50 and 23; and 38, 45 and 18kg CO₂e/year, respectively). Patient transport accounted for an average of 95% (Denmark) to 97% (Italy) of total emissions. UK data will be presented after full analysis.
CONCLUSIONS: This study reflects substantial variation in patient-use CO₂e emissions across RRMS treatments, based on SmPC-defined monitoring requirements and may not fully capture real-world clinical pathways. Additional procedures may further increase emissions. Optimizing travel and selecting lower-emission therapies, when clinically appropriate, can support more sustainable care across evaluated countries.
METHODS: An Excel-based tool was developed to estimate carbon dioxide equivalent (CO₂e) emissions linked to RRMS treatment use following SmPC guidance over a four-year time horizon. Model inputs were sourced from official databases and published literature and subsequently validated by healthcare experts from each country. Emission factors were applied to calculate CO₂e emissions across three domains: medical provider resource use (facility energy consumption and medical devices), patient transportation (distance, visit frequency, modes of transport, and fuel types), and waste generation (units and kilograms by category). Optimization of visits (combining tests or treatment administration) was restricted to reflect real-world practice in Italy, Spain, UK, and Denmark. The analysis followed the Sustainable Care Pathways framework and Publicly Available Specification 2090:2025.
RESULTS: Average annual patient use-phase emissions were 34, 41 and 16kg CO2e in Spain, Italy and Denmark, respectively. Oral treatments consistently showed the lowest mean emissions (32, 35 and 13kg CO₂e/year, respectively), particularly cladribine tablets (7, 13 and 5kg CO₂e/year, respectively), compared with subcutaneous and intravenous options (34, 50 and 23; and 38, 45 and 18kg CO₂e/year, respectively). Patient transport accounted for an average of 95% (Denmark) to 97% (Italy) of total emissions. UK data will be presented after full analysis.
CONCLUSIONS: This study reflects substantial variation in patient-use CO₂e emissions across RRMS treatments, based on SmPC-defined monitoring requirements and may not fully capture real-world clinical pathways. Additional procedures may further increase emissions. Optimizing travel and selecting lower-emission therapies, when clinically appropriate, can support more sustainable care across evaluated countries.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR66
Topic
Health Policy & Regulatory, Health Technology Assessment, Organizational Practices
Disease
Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas